introduction to intensive care medicine for accs trainees sabine eggert swansea 2012

Introduction to Intensive Care Medicine for ACCS trainees

Sabine Eggert

Swansea

2012

Intensive Care Medicine

• Copenhagen 1952 – Ibsen: Technique of positive pressure ventilation widely adopted in polio epidemic with mortality reduction from 90% to 25%.

(Manpower required - 1400 students)

• Positive-pressure ventilators developed (Engstrom)

Intensive Care Medicine

Intensive Care Medicine

• 1970–1980’s – modern concept of critical illness developed. Respiratory support only run by anaesthetists

• 1999 - Awarded specialty status • 2000 - IBITCM established• 2002 - Dual CCT in ICM• 2010 - FICM approved• 2012 - Single CCT in ICM

Intensive Care Medicine

Principles

• Diffusion (Fick’s law)

• Filtration

• Absorption

Intensive Care Medicine

Change over time:

• Equipment• Environment• Patients are older, sicker with higher

expectations

Intensive Care Medicine

Help:• Colleagues

• Nurses

• ITU guidelines

• Computer

Intensive Care MedicineThe ICM team:Consultants (11)

Trainees (21)Parent specialty doctors

Microbiologists, pathologists Nursing staffTechniciansSecretaries

PhysiotherapistsPharmacistsDieticians

ReceptionistsCleaners

Intensive Care Medicine

Intensive Care Medicine

Swansea• 28 ITU beds in Morriston Hospital• No. of admissions: over 1100 per year

– 42% surgical, 58% medical• Tertiary centre – trauma / vascular /

pancreatic disease / renal • Other critical care areas:

• Burns unit• Cardiac ITU

Intensive Care Medicine

Intensive Care Medicine

• Induction Meeting, Appraisal meetings

• 2 ACCS trainees on 1st on call rota

• Allocated to one section of the unit during morning hand-over

• 2 consultant-led ward rounds

• Member of trauma and arrest team

• Ward referrals

Intensive Care Medicine

• Microbiology ward rounds

• Weekly audit / case presentations and journal clubs

• Weekly team based “long stay” patient reviews

• X ray teaching

• Bed side teaching

Intensive Care Medicine

Ward round• System-based presentation:

CVS

RespiratoryNeurologicalRenalGI tractHaematological/ Infections

• Problems• Management plan

Intensive Care Medicine

Duties:

• Interventions

• Referrals

• Relatives

• Discharge summaries

• Death Certificates

Intensive Care Medicine

“ACCS paperwork”

• 6 DOPS

• 3 Mini Cex

• 4 CBD

• 1 MSF

• FICM documentation

• Educational Supervisor Report

Intensive Care Medicine

Single/Dual CCT’s:• Entry routes: Anaesthetics, CMT, EM

ACCS• Primary exam • Primary FICM exam not running yet

(2014?)

Intensive Care Medicine

Single CCT:• Competitive entry at ST3 level

• Primary exam in entry specialty

• Annual interviews in ICM

• National interview process

• Soon: applications for ACCS ICM possible

Intensive Care Medicine

Stage 1 ICM training:• Appointments into ST3 and ST4 ICM training• At the end of ST4 every trainee will have had:

1 year Anaesthetics1 year ICM1 year AM

Intensive Care Medicine

Stage 2 ICM training:• ST 5 year with specialty experience

(cardiac, neuro, paeds plus other)• ST 6 special interest

• Compulsory FICM exam: ST 5/ ST6 level

Intensive Care Medicine

Stage 3 ICM training:

• 1 year of advanced ICM training

Intensive Care Medicine

Dual CCT’s:• CT of 2nd specialty• 2 Applications (within 18 months)• Additional 18 months of training needed• Overlap of competencies

Intensive Care Medicine

Why dual CCT?• Broadens working opportunities• Increasing demand for ICM consultants• Anaesthetics: “peri-operative physician”• AM/EM: close links

Thank you!

Questions?